RAF Scores Not Aligning with Your Care?

RCxRules complements your population health management software. Population health systems do a great job of identifying high-risk patients and even identifying missing HCC codes. RCxRules takes this critical data and incorporates this information directly into the coding workflow. RCxRules' focus is on improved HCC coding capture rates and ensuring accurate HCC codes are documented before they’re submitted as a claim. This focus on the HCC coding workflow and concurrent review is outside the scope of the leading population health solutions in the market.

We firmly believe that robust pre-visit planning is essential to any successful HCC coding strategy. If you already have a process in place that works well for you, that’s great. RCxRules' HCC coding workflow easily complements a variety of pre-visit planning strategies. Regardless of the approach, RCxRules' essential value proposition is automating the review of all patient encounters (concurrent HCC review) to ensure the expected HCC codes were actually captured and will be transmitted to the payer.

A retrospective HCC coding review process occurs after the initial claims have been submitted to a payer. This process is helpful in having coders find HCC opportunities that are reflected in the clinical document, but not captured in the diagnosis coding. While this process is helpful, it’s typically a highly manual process and requires the review of encounters twice (once for the initial claim and again for the retrospective review). Additionally, the process for submitting the newly identified codes through an alternate submission methodology adds redundant time and effort. RCxRule’s approach to HCC coding is to quickly and efficiently address this on the front end. We enable HCC coders to review claims in real-time so accurate HCC coding is captured on the initial claim submission.

No, RCxRules lets your team focus on what they do best. Your providers can continue providing excellent patient care, while coders work out of RCxRules in a process that supports provider’s clinical documentation efforts. Within RCxRules, coders review HCC coding errors before claim submission.

No, RCxRules is designed for the HCC coding process and the standard fee-for-service coding process to function smoothly and efficiently together (see our Revenue Cycle Rules solution). Our HCC coding solution isolates only those HCC encounters needing coder review and directs to a dedicated HCC coding queue. This workflow mirrors the automated review of traditional fee-for-service claims for accuracy before claim submission implemented by virtually all revenue cycle operations.

RCxRules has the built-in intelligence to detect data issues in risk-based patient encounters and fee-for-service based encounters and to automatically direct to the appropriate teams for resolution.

RCxRules can capture patient historical HCC codes from a variety of sources. The majority of customers include the patient’s HCC history from their EMR and revenue cycle management systems. Additionally, many customers will supplement this HCC data with information from their population health management system, or from HCC information their payers can provide to them directly.

The RCxRules HCC coding solution is designed to fully complement your existing population health, EMR, and revenue cycle management systems. RCxRules has a variety of industry standard methods for achieving this integration and our focus is always on using the simplest approach required to meet your needs.

RCxRules has integrated with most major EMR and revenue cycle management systems. This list includes Epic, Cerner, Allscripts, GE, Athena, NextGen as well as many others. Contact us with specific integration questions.